Sleep Quality After Quetiapine Augmentation in Patients With Treatment-Resistant Depression and Personality Disorders

PURPOSE/BACKGROUND

Quetiapine is a first-line augmenting agent for treatment-resistant depression (TRD) and is used off-label in insomnia. Quetiapine and its active metabolite norquetiapine act mostly on 5-HT2A, 5-HT2C, H1, and D2 as antagonists and on 5-HT1A as partial agonists. Patients with TRD often have comorbid personality disorder (PD), and evidence suggests an association between sleep disturbance and recovery among patients with PD. Here, we aimed to evaluate the effects of quetiapine on sleep in TRD patients with and without PD (PD+/PD-).

METHODS/PROCEDURES

We reviewed health records of 38 patients with TRD (20 TRD/PD+) who had been treated with a pharmacotherapy regimen including quetiapine. Clinical outcomes were determined by comparing changes in sleep items of the Hamilton Depression Rating Scale at the beginning (T0) and after 3 months of an unchanged treatment (T3).

FINDINGS/RESULTS

Patients with TRD/PD+ and TRD/PD- taking quetiapine showed significant improvement in sleep items from T0 to T3 (P < 0.001, ηp2 ≥ 0.19). There was a significant personality × time interaction for sleep-maintenance insomnia (P = 0.006, ηp2 = 0.23), with TRD/PD+ showing a greater improvement at T3 compared with TRD/PD- (P = 0.01). While exploring other sleep items, no personality × time interaction was found. In the TRD/PD- group, improvement in sleep items was associated with an overall improvement in depressive symptoms (r = 0.55, P = 0.02).

IMPLICATIONS/CONCLUSIONS

Quetiapine induced greater improvements in sleep-maintenance insomnia among TRD/PD+ patients than TRD/PD-. These findings suggest quetiapine could have a therapeutic role for insomnia in PD underscoring a distinct underlying neurobiological mechanism of sleep disturbance in people living with PD.

Adverse drug events related to mood and emotion in paediatric patients treated for ADHD: A meta-analysis

BACKGROUND

ADHD is frequently comorbid with anxiety and mood disorders, which may increase the severity of inattention and hyperactivity symptoms. Emotional symptoms (anxiety, irritability, mood lability) also affect patients without comorbidity or emerge as adverse drug events. The influence of ADHD drugs on emotional symptoms demands investigation to improve therapies.

METHODS

Systematic review of trials reporting adverse events in patients pharmacologically treated for ADHD. Meta-analysis of the occurrence of irritability, anxiety, apathy, reduced talk, sadness, crying, emotional lability, biting nails, staring, perseveration, euphoria. Meta-regression analysis.

RESULTS

Forty-five trials were meta-analysed. The most frequently reported outcomes were irritability, anxiety, sadness, and apathy. Methylphenidates, especially immediate-release formulations, were most studied; amphetamines were half as studied and were predominantly mixed amphetamine salts. Reports on atomoxetine were scant. Meta-analysis showed that methylphenidates reduced the risk of irritability, anxiety, euphoria, whereas they worsened the risk of apathy and reduced talk; amphetamines worsened the risk of emotional lability. Factors influencing risks were study year and design, patients' sex and age, drug dose and release formulation.

LIMITATIONS

Possible discrepancy between adverse events as indicated in clinical trials and as summarised herein. Confounding due to the aggregation of drugs into groups; uninvestigated sources of bias; incomplete lists of adverse events; lack of observations on self-injury.

CONCLUSIONS

Methylphenidates appeared safer than amphetamines, although younger patients and females may incur higher risks, especially with high-dose, immediate-release methylphenidates. Only atomoxetine holds a black-box warning, but amphetamines and methylphenidates also did not show a safe profile regarding mood and emotional symptoms.

Long-term use of psychedelic drugs is associated with differences in brain structure and personality in humans

Psychedelic agents have a long history of use by humans for their capacity to induce profound modifications in perception, emotion and cognitive processes. Despite increasing knowledge of the neural mechanisms involved in the acute effects of these drugs, the impact of sustained psychedelic use on the human brain remains largely unknown. Molecular pharmacology studies have shown that psychedelic 5-hydroxytryptamine (5HT)2A agonists stimulate neurotrophic and transcription factors associated with synaptic plasticity. These data suggest that psychedelics could potentially induce structural changes in brain tissue. Here we looked for differences in cortical thickness (CT) in regular users of psychedelics. We obtained magnetic resonance imaging (MRI) images of the brains of 22 regular users of ayahuasca (a preparation whose active principle is the psychedelic 5HT2A agonist N,N-dimethyltryptamine (DMT)) and 22 controls matched for age, sex, years of education, verbal IQ and fluid IQ. Ayahuasca users showed significant CT differences in midline structures of the brain, with thinning in the posterior cingulate cortex (PCC), a key node of the default mode network. CT values in the PCC were inversely correlated with the intensity and duration of prior use of ayahuasca and with scores on self-transcendence, a personality trait measuring religiousness, transpersonal feelings and spirituality. Although direct causation cannot be established, these data suggest that regular use of psychedelic drugs could potentially lead to structural changes in brain areas supporting attentional processes, self-referential thought, and internal mentation. These changes could underlie the previously reported personality changes in long-term users and highlight the involvement of the PCC in the effects of psychedelics.

[A case of ketamine dependence]

Ketamine is a rapid-acting anaesthetic agent which has been used for over 40 years. It is an antagonist of N-methyl-D-aspartate (NMDA) receptors and agonist of mu and sigma opiate receptors. Ketamine acts through inhibition of sensory parts in the brain and stimulation of the limbic system and optic thalamus. The most common psychiatric disorders observed after the use of ketamine are: psychomotor agitation, hallucinations, status of stupor, consciousness disorders. There are observed cases of non-medical use of ketamine since the sixties of the 20th century. The authors describe the case of a 52 year old man who has been addicted to ketamine for 15 years. The patient was admitted to hospital to observe and treat the withdrawal syndrome as an effect of abrupt discontinuation of a chronically abused substance. On the ground of medical examinations, standard tests, anamnesis and hospital observation, ketamine dependence syndrome of a person with personality disorders was recognized. There was no somatic symptoms of withdrawal syndrome observed. The patient complained of sleep disorders and anxiety. Diazepam, carbamazepine and vitamins was used during treatment. The patient was motivated to stop using ketamine. This case and the described symptoms were compared with others articles.

Hypersexuality and paraphilia induced by selegiline in Parkinson's disease: report of 2 cases

While hypersexuality and paraphilia are known side effects of anti-Parkinson medications, it is seldom reported. Furthermore, selegiline is rarely implicated in such behaviors. We report two cases of early onset PD who experienced paraphilia and hypersexuality when selegiline was initiated, and later developing obsessive-compulsive and punding behavior with the addition of dopamine agonists. Social repercussions may prohibit patients and/or their families from volunteering such information.

Fluoxetine 40-60 mg versus fluoxetine 20 mg in the treatment of children and adolescents with a less-than-complete response to nine-week treatment with fluoxetine 10-20 mg: a pilot study

OBJECTIVE

The aim of this study was to compare fluoxetine dosage titration to 40-60 mg/day with fixed fluoxetine 20-mg/day treatment for an additional 10 weeks in pediatric outpatients with major depressive disorder (MDD) who had not met protocol-defined response criteria after 9-week acute fluoxetine treatment.

METHODS

Patients unresponsive (less than or equal to 30% decrease in Children's Depression Rating Scale-Revised [CDRS-R] score) after 9-week fluoxetine treatment were randomly reassigned to continue at 20 mg/day or to increase to 40 mg/day. After 4 weeks, patients unresponsive to 40 mg/day could receive 60 mg/day.

RESULTS

Twenty-nine (29) patients, 9-17 years of age, received fluoxetine 40-60 mg/day (n = 14) or 20 mg/day (n = 15). At the conclusion of this study phase, 10 patients (71%) on 40-60 mg/day met the response criteria, versus 5 patients (36%) on 20 mg/day (p = 0.128). Mean CDRS-R scores improved in both treatment groups (fluoxetine 40-60 mg/day, -9.4; fluoxetine 20 mg/day, -1.5; p = 0.099). Adverse events were similar in both groups. However, this study phase was statistically underpowered for detecting differences between treatment groups.

CONCLUSION

More than two thirds of patients whose dosage was increased responded within 10 weeks, suggesting dose escalation may benefit some patients. Approximately one third of patients unresponsive to initial treatment with fluoxetine 20 mg responded to this fixed dosage within another 10 weeks. Fluoxetine 20-60 mg/day was well tolerated.

Internal cue exposure and the treatment of substance use disorders: lessons from the treatment of panic disorder

Despite early recognition of the importance of internal cues (craving sensations and emotional states) for relapse in substance use disorders, relatively little attention has been devoted to exposure-based treatments targeting these cues. Drawing upon research on the conceptualization and treatment of panic disorder, we discuss the application of internal (largely emotional) cue exposure for substance use disorders. Our model for this discussion was based on the role of exposure to feared sensations of anxiety in the treatment of panic disorder and benzodiazepine (BZ) discontinuation. Shared research strategies between panic disorder and substance use--studies of biological provocation and anxiety sensitivity--were discussed, as were gender differences in drug-use motives. In accordance with research on anxiety sensitivity, provocation effects, and the treatment of benzodiazepine withdrawal, we discussed the potential value of internal cue-exposure strategies for individuals who use substances as a way to cope with negative affect.

An assessment of the impact of thimerosal on childhood neurodevelopmental disorders

The prevalence of autism in the US has risen from 1 in approximately 2500 in the mid-1980s to 1 in approximately 300 children in the mid-1990s. The purpose of this study was to evaluate whether mercury from thimerosal in childhood vaccines contributed to neurodevelopmental disorders. Neurodevelopmental disorder dose-response curves for increasing mercury doses of thimerosal in childhood vaccines were determined based upon examination of the Vaccine Adverse Events Reporting System (VAERS) database and the 2001 US' Department of Education Report. The instantaneous dosage of mercury children received in comparison to the Food and Drug Administration (FDA)'s maximum permissible dose for the oral ingestion of methylmercury was also determined. The dose-response curves showed increases in odds ratios of neurodevelopmental disorders from both the VAERS and US Department of Education data closely linearly correlated with increasing doses of mercury from thimerosal-containing childhood vaccines and that for overall odds ratios statistical significance was achieved. Similar slopes and linear regression coefficients for autism odds ratios in VAERS and the US Department of Education data help to mutually validate each other. Controls employed in the VAERS and US Department of Education data showed minimal biases. The evidence presented here shows that the occurrence of neurodevelopmental disorders following thimerosal-containing childhood vaccines does not appear to be coincidental.

Understanding the causes of problematic pain management in sickle cell disease: evidence that pseudoaddiction plays a more important role than genuine analgesic dependence

Treatment of painful episodes in sickle cell disease (SCD) is sometimes complicated by disputes between patients and staff and patient behaviors that raise concerns about analgesic misuse. Those concern-raising behaviors could indicate either drug seeking caused by analgesic dependence or pseudoaddiction caused by undertreatment of pain. To make a systematic assessment of concern-raising behaviors and examine their associations with other factors, including DSM-IV symptoms of substance dependence, individual, in-depth interviews with SCD patients were conducted to apply pre-established criteria for concern-raising behaviors. These included disputes with staff tampering with analgesic delivery systems, passing prescribed analgesics from one person to another, being suspected or accused of analgesic misuse, self-discharging from hospital, obtaining analgesic prescriptions from multiple sources, using illicit drugs, and injecting analgesics. Assessments were also made of pain-related symptoms of substance dependence (where behaviors resemble substance dependence but reflect attempts to manage pain, increasing the risk of pseudoaddiction), non-pain-related symptoms of substance dependence (where substance dependence reflects analgesic use beyond pain management), and pain coping strategies (using the Pain Coping Strategies Questionnaire). Inter-rater reliability for the assessment of concern-raising behaviors was high, with Kappa coefficients of 0.63 to 1.0. The most frequent concern-raising behaviors were disputes with staff about pain or analgesics. The least frequent were tampering with analgesic delivery systems and passing analgesics between patients in hospital. The odds of concern-raising behaviors in hospital were raised eightfold by less use of ignoring pain as a coping strategy, and more than doubled by each additional pain-related symptom of substance dependence. Non-pain-related symptoms of substance dependence had no independent effect on concern-raising behaviors. Concern-raising behaviors were more closely associated with pain behaviors that make patients vulnerable to misperceptions of substance dependence than they were with genuine substance dependence. The results show how pseudoaddiction can adversely influence hospital pain management, and suggest that more emphasis should be placed on patients' pain and analgesic needs when responding to concern-raising behaviors in hospital.

The patient with medication overuse: clinical management problems

Patients with chronic headache arise many problems in clinical management, often strictly related to medication overuse. IHS classification did not clear the different clinical presentation and a chapter dedicated to this problem is lacking. This condition is very frequently associated with psychiatric illness, so that the clinical features become more complex over the years. Most of patients share a past clinical condition of episodic migraine; this aspect is very important facing the therapeutical phase, because after discontinuing medication overuse, if present, the treatment must be direct toward this disease. To treat a patient with analgesic, or ergotamine, or triptan abuse, require much caution because stopping the drug may arise new problems, such as different headache, abstinence syndrome, epileptic seizures etc. We review the different possibility that we have to manage the overuser patient.

Personality and symptom sensitivity predictors of alprazolam withdrawal in panic disorder

BACKGROUND

Discontinuation of benzodiazepine (BZ) treatment results in a well-characterized withdrawal syndrome in 40-50% of anxious patients. While numerous studies have established the role of BZ dose, treatment duration, half-life, potency, rate of withdrawal and severity of underling anxiety disorder in predicting severity of withdrawal symptoms, fewer studies have examined the role of psychological and personality factors.

METHOD

In 123 panic disorder patients undergoing gradual tapered discontinuation of alprazolam in conjunction with pre-treatment with carbamazepine or placebo, the relationship between measures of 'symptom sensitivity' and 'harm avoidance', and severity of withdrawal symptoms measured as peak severity of symptoms, time before taper needed to be slowed due to symptoms, and ability to complete taper, was examined.

RESULTS

After controlling for the less substantial effects of dose, treatment duration, pre-taper anxiety and panic attack frequency, measures of symptom sensitivity and harm avoidance accounted for an additional 3-6% of withdrawal variance.

CONCLUSIONS

These results show an effect of symptom sensitivity and harm avoidance on BZ withdrawal symptoms, comparable to prior findings linking dependent personality characteristics to withdrawal severity. Failure to show the expected effect on ability to complete taper may be due to either the more symptomatic nature of the patients in this study.

Low-dose recombinant IL-2 induces psychological changes: monitoring by Minnesota Multiphasic Personality Inventory (MMPI)

BACKGROUND

Chronic subcutaneous rIL-2 at low doses produces long-lasting immunomodulatory effects and is considered an effective treatment for renal cell carcinoma with marginal activity in malignant melanoma and colorectal cancer.

PATIENTS AND METHODS

In this study we evaluated, by Minnesota Multiphasic Personality Inventory (MMPI), the psychological changes induced by rIL-2 in 10 patients with advanced tumors.

RESULTS

After 3 months of rIL-2 treatment, 80% of the patients had a significantly increased score on the clinical scale of depression (D) and psychasthenia (Pt) (p<0.01), 70% on the scale of conversion hysteria (Hy) and 60% on the scales of schizophrenia (Sc) and psychopathic deviate (Pd), (p<0.05). These MMPI changes were however not paralleled by disease progression or clinical-overt psychological disease.

CONCLUSION

These findings demonstrate that low-dose rIL-2 is a psychoactive treatment, which deserves psychological monitoring The MMPI is feasible for the evaluation of subclinical psychological modifications induced by cytokine immunotherapy.

Mood and behavioral symptoms in individuals with chronic solvent exposure

Psychiatric symptoms have been reported for individuals who experience chronic exposure to low levels of organic solvents. However, it is not known what proportion of such individuals experience psychiatric disorder; which specific disorders may be characteristic of this population; or whether bioaccumulation of lead contributes to the relationship between solvent exposure and psychiatric symptoms. Twenty-nine male journeymen painters and 32 male non-painter control subjects were administered semi-structured diagnostic interviews for DSM-III-R Axis I and Axis II disorders. Career solvent exposure and blood lead levels were also measured. Painters and control subjects did not differ significantly with respect to age, intelligence, or demographic characteristics. Results showed that the probability of being diagnosed with a mood disorder differed significantly in painters (41%) and control subjects (16%). Painters (66%) and control subjects (50%) did not differ for substance use diagnoses. Groups also did not differ for personality disorders involving an onset before 25 years of age. In contrast, painters exhibited a sub-clinical pattern of personality dysfunction involving symptomatology that was measured allowing for late onset (after age 25). Finally, a significant dose-response relationship was observed between career solvent exposure, blood lead level, and personality symptoms. In summary, these data showed an increased rate of psychological disturbance in a significant and substantial number of painters. However, not all painters were so characterized. This overall pattern raises a question regarding a potential role for differential vulnerability, which requires empirical validation.

Personality changes in adult subjects with major depressive disorder or obsessive-compulsive disorder treated with paroxetine

BACKGROUND

Human and animal studies point to 3 dimensions of personality that change during pharmacotherapy with a selective serotonin reuptake inhibitor (SSRI). Specifically, harm avoidance has been found to decrease, social dominance has been found to increase, and hostility in social situations has been found to decrease with SSRI treatment. We sought to determine personality changes in subjects with either major depressive disorder (MDD) or obsessive-compulsive disorder (OCD) treated with paroxetine. We also sought to determine whether or not these personality changes were associated with disease state (MDD vs. OCD) or treatment response (responders vs. nonresponders).

METHOD

Thirty-seven subjects diagnosed with either MDD or OCD (according to DSM-IV criteria) completed the Cattell 16 Personality Factor Inventory (16-PF) before and after treatment with paroxetine. Treatment response was defined as a Clinical Global Impressions-Improvement rating of "much" or "very much" improved and a drop in Hamilton Rating Scale for Depression score of at least 50% for MDD or Yale-Brown Obsessive Compulsive Scale score of at least 30% for OCD.

RESULTS

No significant differences were found between subjects with MDD and OCD in personality change with treatment. In the whole group, treatment responders had a greater decrease than nonresponders in 16-PF factors relating to harm avoidance. An increase in social dominance factors and a decrease in factors relating to hostility in social situations were found, but these changes were not significantly different between responders and nonresponders.

CONCLUSION

These findings indicate that certain personality dimensions change with SSRI treatment and that some of these changes are independent of clinical treatment response.

Do hallucinogens cause residual neuropsychological toxicity?

We collected and reviewed studies in which neuropsychological tests were administered to users of LSD or other hallucinogens. Interpretation of the studies is limited by various confounding variables, such as subjects' premorbid cognitive and personality function and prior use of other substances. At present, the literature tentatively suggests that there are few, if any, long-term neuropsychological deficits attributable to hallucinogen use. To better resolve this issue, however, it will be important to study larger samples of chronic, frequent hallucinogen users who have not often used other types of drugs.

[Psychoemotional disorders in those working with epoxy compounds]

Psychoemotional status was studied in 125 female workers 21 to 50 years old having been exposed to epoxide resins and their compounds for 5 to 25 years. We undertook to carry out multifactor questionnaire survey together with pathopsychological testing, and determining levels of personal constitutional and reactive anxiety. Occupation-related neurotic disorders (neurasthenic-, obsessive and phobic-, and, to a lesser extent, hysterical type manifestations) were found out to develop during the stage of prenosologic forms against the background of high level of both constitutional and reactive anxiety. It is psychoconstitutional traits of workers being predisposing factors for the disorders in question that affect the epoxide-related origination and development of psychoemotional derangement. The following traits can be regarded as predisposing factors for derangement: excitability, bias towards anxiety, deestiming, demonstrable behaviour.

[Mental disorders in workers exposed to chemicals at work]

The article considers data on boundary psychic disorders in subjects exposed to chemicals of I-II jeopardy classes. Chemical factor appears to increase risk of psychiatric diseases. The authors suggest periodic psychiatric examination of workers engaged into hazardous chemical production for better occupational selection, early diagnosis and treatment of boundary psychic disorders.

A high prevalence of abnormal personality traits in chronic users of anabolic-androgenic steroids

OBJECTIVE

(1) To assess the personality profiles of the anabolic androgenic steroid users (AAS) and (2) to determine whether valid premorbid personality traits could be obtained from cross sectional assessment using multisource data.

METHODS

The first author became a participant-observer in a group of body builders. An experimental group of body builders who had been using AAS for no more than 18 months (n = 12) was identified. A group of control subjects, each of whom claimed that he did not, and never had, used AAS (n = 12) was also recruited during this period. Key informants played a crucial role in recruiting subjects representative of the AAS and body building communities. An interview schedule based on the Diagnostic and statistical manual of mental disorders (DSM3-R) personality disorder criteria was conducted with each subject. Additional data were obtained from an AAS using informant and significant others including family and friends.

RESULTS

The user group was significantly heavier than the control group and showed abnormal personality traits, in contrast to the control group. Personality traits of AAS users before the onset of AAS use, assessed retrospectively, were not different from personality traits of control subjects. There were significant differences between the before and after personality traits in AAS user group.

CONCLUSIONS

The results suggest (1) that AAS use is associated with significant disturbances in personality profile, and (2) that these personality disturbances are possibly the direct result of AAS use.

[Psychopathology associated with drug consumption]

Psychiatric disorders are studied in a 94 drug addict population using structured interviews. Beck Depression Inventory and DSM-III and CIE-9 criteria for diagnosis. Fifty five percent of drug abusers have a psychiatric disorder not related with drug abuse. Personality disorders and affective disorders are the most frequent diagnosis.

Affective and personality disturbances among female former microelectronics workers

The production and manufacture of microelectronic components, carried out primarily by women workers, require extensive use of organic solvents. Affective and personality disturbances frequently have been associated with organic solvent toxicity. A group of women, former microelectronics workers (N = 70), primarily of Hispanic origin (77.1%) but raised in the United States, were evaluated for affective and personality disturbance with the MMPI. Profiles were analyzed, and diagnostic classification was performed blind. Results showed that (1) 85.7% of the profiles indicated abnormally high clinical elevations; and (2) MMPI profile classification revealed four clinical diagnostic groups: somatoform (24.3%), depression (15.7%), anxiety (28.6%), and psychotic (14.3%). These findings indicate significant psychopathology among these women, who formerly had worked in a microelectronics plant. The patterns of impairment present similarities to previous reports of organic solvent toxicity.

A distinct pattern of personality disturbance following exposure to mixtures of organic solvents

To assess systematically the pattern of psychologic distress in chemically exposed workers complaining of personality changes, we administered the Minnesota Multiphasic Personality Inventory to 22 men with a history of exposure to mixtures of organic solvents. Results indicated clinically significant profile elevations in more than 90% of the exposed workers. Moreover, a consistent response profile was noted, indicating a high rate of somatic disturbances, anxiety, depression, social isolation, and fear of losing control. In addition, those workers with the longest exposure duration had the highest elevations on the scale measuring disturbances of thinking, social alienation, poor concentration, and anxiety. Comparisons between these subjects and a group of former prisoners of war with posttraumatic stress disorder revealed strikingly similar clinical profiles. We present a case history that illustrates the nature of this psychologic disturbance.

Psychiatric complications of long-term interferon alfa therapy

Ten (17%) of 58 patients with chronic viral hepatitis treated with a four- to 12-month course of recombinant human interferon alfa developed psychiatric side effects. The psychiatric side effects fell into three categories: an organic personality syndrome characterized by irritability and short temper; an organic affective syndrome marked by extreme emotional lability, depression, and tearfulness; and a delirium marked by clouding of consciousness, agitation, paranoia, and suicidal potential. These psychiatric side effects appeared after one to three months of therapy, usually improved within three to four days of decreasing the dose of interferon alfa, and invariably resolved once therapy was stopped. The organic personality and affective syndromes tended to occur in patients who received the highest dose of interferon alfa, who had relatively mild hepatitis, and who lost weight during interferon treatment. Delirium tended to occur in patients with severe hepatitis who had previous evidence of organic brain injury or dysfunction or previous drug and alcohol abuse. Failure to recognize these side effects quickly and to treat them with supportive therapy and modification of the dose of interferon alfa could result in limitation of therapy and serious personal and interpersonal consequences.

Volatile substance abuse: a review of possible long-term neurological, intellectual and psychiatric sequelae

The possibility that chronic abuse of volatile substances can cause permanent neurological, psychiatric, and intellectual sequelae is critically reviewed. Toluene, present in the commonly used adhesives, is most often implicated in 'glue sniffing'; this review focuses on its potential long-term effects. Many criticisms--particularly poor matching of control samples and inability to distinguish between acute and chronic effects--can be levelled at the available studies, while no adequate follow-up studies have been performed. In the light of present knowledge, the possibility that permanent structural brain damage, with accompanying psychiatric manifestations, results from solvent abuse remains inconclusive.

[Psychological effects in the drug treatment of arterial hypertension. A study during a community preventive program]

The possibility that antihypertensive drug treatment may induce neurotic symptoms was investigated in a random sample of 114 hypertensives enrolled in an "Hypertension Register" by means of the Kellner and Sheffield Symptom Rating Test (S.R.T.). Of them 73 were on antihypertensive treatment; 41 untreated subjects constituted the control group. Covariance analysis adjusting for age and diastolic blood pressure was used as a statistical test. The comparison between treated and not treated hypertensive subjects did not show any significant difference either for total S.R.T. score (12.6 vs 10.6 in M, 11.6 vs 14.6 in F), or for the partial scores of anxiety (3.5 vs 3.0 in M, 3.1 vs 3.4 in F), depression (2.4 vs 2.2 in M, 2.7 vs 3.5 in F), somatization (4.2 vs 3.2 in M, 3.9 vs 5.6 in F), inadequacy (2.4 vs 2.1 in M, 1.9 vs 2.1 in F). Taking into account the total group (M + F) of treated hypertensives, no significant differences were observed between different treatments (reserpine, alphamethyldopa, clonidine; beta-blockers, diuretics). However beta-blockers and clonidine showed the highest scores for total S.R.T. score (17.3 and 13.2 respectively). The study suggests that the antihypertensive drugs taken into consideration, at least at the given regime, do not induce such psychological side effects as to prevent them being used in a programme of secondary prevention of hypertension.

Parkinson's disease in the elderly: psychiatric manifestations

Drug-induced psychiatric symptoms are usually reversible within days. However, if the patient also has cognitive impairment of a more permanent nature, improvement may not be seen for weeks or even months. During the year preceding the diagnosis of Parkinson's disease, the incidence of depression, hyperirritability, and instability of emotions is significant. After the onset of Parkinson's disease, depression is very common.

[Remarks on the value of psychological efficiency diagnostics for the diagnosis and therapy of alcoholism--response to Szewczyk on our "Chronic alcoholism and psychological efficiency"]

For a clarification of different viewpoints with respect to the importance of efficiency-diagnostic studies in chronic alcoholism, First the question is studied whether there is a common basis of judgement with Szewczyk. On the basis of examples it is shown that there is no agreement with regard to essential facts and contrary conclusions are drawn. The necessity of efficiency-psychological studies of the amnestic psychosyndrome as a constituting components of alcoholic changes of the personality is, for example, derived from diagnostic and therapeutical questions concerning the degree of severity and the pattern of the course of the disease. In progressing alcoholism, the constituting component "amnestic psychosyndrome" is frequently the dominating component in the sense of a pronounced organic psychosyndrome. After long-term abstinence, remarkable improvements of cognitive performances have been found with differentiating efficiency-diagnostic methods. From these facts alone the conclusion can be drawn that there is a wide range of indications for efficiency-diagnostic longitudinal and cross-sectional studies in chronic alcoholics.

Vestibular dysfunction in occupational chronic solvent intoxication

Neurotoxic volatile organic solvents used by house and car painters may lead to professional toxic encephalopathy after several years of exposure. The symptoms are memory impairment, fatigue, personality changes, headache and dizziness. Vestibular dysfunction was found in 55% of 113 painters examined, mainly in the form of reduced caloric vestibular reactions. No correlation between vestibular dysfunction and the duration of exposure, cerebral atrophy or intellectual impairment could be demonstrated. Vestibular examination may be helpful in detecting early changes in exposed persons and in determining more accurate safety limits for harmful chemicals.

[Psychic disturbances in women during oral contraception (author's transl)]

Methodically accurate psychiatric and psychological investigations have shown that psychological disorders in connection with oral contraception are more frequent than in generally known. The psychological changes in the sense of the endocrine psychosyndrome appear as fine disorders of mood, impulse and elemental urge. Not least, they have general mental hygienic significance, because in connection with them activity and spontaneity and also the ability to work are disturbed. From these psychobiological findings a qualitative differential sensitivity of the organism (as a reaction to different pharmacological substances) can be read. These results can initiate a comprehensive formulation of the psychosomatic personality theory.

Psychological changes in children after anaesthesia: a comparison between halothane and ketamine

The psychological reactions to hospitalization, anaesthesia, and operation in a group of 107 children from 1 to 12 years old, anaesthetized with ketamine or halothane after randomization were investigated through questionnaires, which the parents answered 1 month postoperatively. The percentage of replies was 96.3%. Fifty-three children were anaesthetized with ketamine and 50 with halothane. Thirteen children in the ketamine group and nine in the halothane group reacted with negative personality changes; the reactions were of less than 1 month's duration and were most frequent in the youngest children. The parents' preparation of the children had no influence on the results. The number of personality changes caused by the two anaesthetic agents did not differ significantly. Furthermore, the investigation showed the nine children reacted for the better. Thirty-six per cent of the parents felt insufficiently informed of what the hospitalization implied for their child.

Behavioral effects of long-term exposure to a mixture of organic solvents

The behavioral effects of long-term exposure to a mixture of organic solvents were investigated in a comparison of the test results of 100 car painters with those of a reference group. The test battery included tests for intelligence, memory, psychomotor performances, and personality. In addition to the comparison of the mean results, two discriminant function analyses were made. In one, only the performance test variables were used, but in the other personality variables were also included. The results indicated impairments in psychological performances, as well as personality changes in the exposed group. Impairments in visual intelligence and verbal memory and a reduction of emotional reactivity were the central features of the adverse effects of solvent exposure, but the behavioral disturbances also involved several other functions, including performance on a verbal intelligence test. The possible role of the differences in the initial intelligence levels were controlled with a separate comparison of the test results of 33 pairs of exposed and nonexposed subjects who were matched for age and for their intelligence level, measured during the military service. The discriminant function analyses were based on the results of these matched subgroups and tested in the rest of the material. According to the results the sensitivity of the psychological test methods was high, but the specificity somewhat low, with regard to solvent exposure. The concentration of various solvents included in the exposure of car painters were low, the summated exposure corresponding corresponding to 32% of the Finnish threshold limit value. The possible role of a potentiating effect of the solvent in the development of behavioral disturbances is discussed.

[Differential diagnosis and syndrome-genetic problems and aspects of drug-induced psychoses in juveniles (author's transl)]

Acute and chronic psychotic states in juvenile drug addicts demand careful observation of syndrome-genetic and differential diagnostic factors. Not only the diagnosis of a schizophrenic or affective juvenile psychosis and their differentiation from phase-specific developmental crises may often be difficult. A further problematic field are special aspects of symptomatic psychoses and particularly states due to drug addiction with hashish, LSD and amphetamines and the effect of drugs on already existing endogenous psychoses. This demands subtile phenomenologic description and syndrome-genetic assessment. One will have to take into account the complexity of drug effects and whether a psychosis existed already before addiction, whether drugs have provoked a latent psychosis, whether a purely symptomatic psychosis mimics a schizophrenia or whether irreversible personality changes with secondary psychotic behavior have developed.